The feasibility and acceptability of a task-shifted intervention for perinatal depression among women living with HIV in Malawi: a qualitative analysis.
HIV
Malawi
Mental health
Perinatal depression
Task-shifting
Journal
BMC psychiatry
ISSN: 1471-244X
Titre abrégé: BMC Psychiatry
Pays: England
ID NLM: 100968559
Informations de publication
Date de publication:
29 12 2022
29 12 2022
Historique:
received:
18
01
2022
accepted:
15
12
2022
entrez:
29
12
2022
pubmed:
30
12
2022
medline:
3
1
2023
Statut:
epublish
Résumé
Perinatal depression (PND) is prevalent and negatively impacts HIV care among women living with HIV (WLHIV), yet PND remains under-identified in Malawian WLHIV. Accordingly, this formative study explored perceptions of the feasibility and acceptability of an integrated, task-shifted approach to PND screening and treatment in maternity clinics. We completed consecutive PND screenings of HIV+ women attending pre- or post-natal appointments at 5 clinics in Lilongwe district, Malawi. We conducted in-depth interviews with the first 4-5 women presenting with PND per site (n = 24 total) from July to August 2018. PND classification was based on a score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS). We conducted 10 additional in-depth interviews with HIV and mental health providers at the 5 clinics. Most participants endorsed the feasibility of integrated PND screening, as they believed that PND had potential for significant morbidity. Among providers, identified barriers to screening were negative staff attitudes toward additional work, inadequate staffing numbers and time constraints. Suggested solutions to barriers were health worker training, supervision, and a brief screening tool. Patient-centered counselling strategies were favored over medication by WLHIV as the acceptable treatment of choice, with providers supporting the role of medication to be restricted to severe depression. Providers identified nurses as the most suitable health workers to deliver task-shifted interventions and emphasized further training as a requirement to ensure successful task shifting. Improving PND in a simple, task-shifted intervention is essential for supporting mental health among women with PND and HIV. Our results suggest that an effective PND intervention for this population should include a brief, streamlined PND screening questionnaire and individualized counselling for those who have PND, with supplemental support groups and depression medication readily available. These study results support the development of a PND intervention to address the gap in treatment of PND and HIV among WLHIV in Malawi.
Sections du résumé
BACKGROUND
Perinatal depression (PND) is prevalent and negatively impacts HIV care among women living with HIV (WLHIV), yet PND remains under-identified in Malawian WLHIV. Accordingly, this formative study explored perceptions of the feasibility and acceptability of an integrated, task-shifted approach to PND screening and treatment in maternity clinics.
METHODS
We completed consecutive PND screenings of HIV+ women attending pre- or post-natal appointments at 5 clinics in Lilongwe district, Malawi. We conducted in-depth interviews with the first 4-5 women presenting with PND per site (n = 24 total) from July to August 2018. PND classification was based on a score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS). We conducted 10 additional in-depth interviews with HIV and mental health providers at the 5 clinics.
RESULTS
Most participants endorsed the feasibility of integrated PND screening, as they believed that PND had potential for significant morbidity. Among providers, identified barriers to screening were negative staff attitudes toward additional work, inadequate staffing numbers and time constraints. Suggested solutions to barriers were health worker training, supervision, and a brief screening tool. Patient-centered counselling strategies were favored over medication by WLHIV as the acceptable treatment of choice, with providers supporting the role of medication to be restricted to severe depression. Providers identified nurses as the most suitable health workers to deliver task-shifted interventions and emphasized further training as a requirement to ensure successful task shifting.
CONCLUSION
Improving PND in a simple, task-shifted intervention is essential for supporting mental health among women with PND and HIV. Our results suggest that an effective PND intervention for this population should include a brief, streamlined PND screening questionnaire and individualized counselling for those who have PND, with supplemental support groups and depression medication readily available. These study results support the development of a PND intervention to address the gap in treatment of PND and HIV among WLHIV in Malawi.
Identifiants
pubmed: 36581849
doi: 10.1186/s12888-022-04476-z
pii: 10.1186/s12888-022-04476-z
pmc: PMC9798611
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
833Subventions
Organisme : FIC NIH HHS
ID : D43 TW011794
Pays : United States
Organisme : FIC NIH HHS
ID : D43TW010060
Pays : United States
Organisme : AHRQ HHS
ID : T32 HS000032
Pays : United States
Organisme : NIAID NIH HHS
ID : P30 AI050410
Pays : United States
Organisme : NICHD NIH HHS
ID : T32 HD007168
Pays : United States
Organisme : NIDA NIH HHS
ID : R25 DA037190
Pays : United States
Organisme : NIAID NIH HHS
ID : T32 AI070114
Pays : United States
Organisme : NICHD NIH HHS
ID : P2C HD050924
Pays : United States
Organisme : FIC NIH HHS
ID : D43 TW010060
Pays : United States
Organisme : NIMH NIH HHS
ID : R34 MH116806
Pays : United States
Informations de copyright
© 2022. The Author(s).
Références
Obstet Gynecol. 2017 Mar;129(3):422-430
pubmed: 28178041
Malawi Med J. 2015 Dec;27(4):145-50
pubmed: 26955436
J Acquir Immune Defic Syndr. 2014 Dec 1;67 Suppl 4:S188-94
pubmed: 25436817
AIDS Patient Care STDS. 2015 Mar;29(3):126-32
pubmed: 25612217
AIDS Behav. 2011 Aug;15(6):1161-70
pubmed: 20711651
Arch Womens Ment Health. 2010 Jun;13(3):201-6
pubmed: 19760051
Infect Dis Poverty. 2020 Jun 5;9(1):62
pubmed: 32503667
Ment Health Fam Med. 2010 Dec;7(4):239-47
pubmed: 22477948
AIDS Behav. 2014 Jun;18(6):1152-73
pubmed: 24584458
J Acquir Immune Defic Syndr. 2014 Dec 1;67 Suppl 4:S179-87
pubmed: 25436816
Dev World Bioeth. 2018 Dec;18(4):406-419
pubmed: 28816023
Br Med Bull. 2012;101:57-79
pubmed: 22130907
J Am Acad Child Adolesc Psychiatry. 2008 Apr;47(4):390-398
pubmed: 18388761
J Affect Disord. 2014 Apr;158:78-84
pubmed: 24655769
Soc Psychiatry Psychiatr Epidemiol. 2019 Oct;54(10):1219-1230
pubmed: 31111166
J Affect Disord. 2018 Oct 15;239:115-122
pubmed: 29990658
J Affect Disord. 2013 Sep 25;150(3):1041-7
pubmed: 23769290
BMC Health Serv Res. 2018 Mar 23;18(1):205
pubmed: 29566680
Soc Sci Med. 2022 Jan;292:114523
pubmed: 34785096
Malays Fam Physician. 2008 Apr 30;3(1):14-20
pubmed: 25606106
AIDS. 2014 Feb 20;28(4):589-598
pubmed: 24468999
Arch Womens Ment Health. 2014 Apr;17(2):145-54
pubmed: 24240635
Health Technol Assess. 2009 Jul;13(36):1-145, 147-230
pubmed: 19624978
BMC Public Health. 2011 Oct 26;11:828
pubmed: 22029430
J Affect Disord. 2010 Jun;123(1-3):17-29
pubmed: 19635636
J Matern Fetal Neonatal Med. 2014 Jun;27(9):960-7
pubmed: 24044422
Lancet Psychiatry. 2014 Jul;1(2):159-62
pubmed: 26360580
Trop Med Int Health. 2014 Nov;19(11):1360-6
pubmed: 25087778
Mhealth. 2019 Sep 12;5:32
pubmed: 31620459
Healthcare (Basel). 2016 Jun 29;4(3):
pubmed: 27417624
Reprod Health. 2018 Sep 21;15(1):158
pubmed: 30241542
S Afr J Psychiatr. 2019 Oct 24;25(0):1404
pubmed: 31745444
J Clin Psychiatry. 2015 Oct;76(10):1385-96
pubmed: 26528645
Health Policy Plan. 2015 Jul;30(6):791-803
pubmed: 25012090
AIDS Care. 2013;25(7):854-62
pubmed: 23383726
BMC Psychiatry. 2016 May 26;16:164
pubmed: 27228979
AIDS Care. 2018 Nov;30(11):1372-1379
pubmed: 29575943
BMC Pregnancy Childbirth. 2014 Dec 03;14:400
pubmed: 25467187
JAMA. 2016 Dec 27;316(24):2618-2626
pubmed: 28027368
Behav Res Ther. 2020 Jul;130:103466
pubmed: 31733813
Ann Glob Health. 2016 Sep - Oct;82(5):922-935
pubmed: 28283147
BMC Res Notes. 2016 Dec 8;9(1):506
pubmed: 27931248
Br J Psychiatry. 1987 Jun;150:782-6
pubmed: 3651732
Int J Soc Psychiatry. 2014 Mar;60(2):155-61
pubmed: 23399989
J Affect Disord. 2017 Sep;219:86-92
pubmed: 28531848
Matern Child Nutr. 2019 Apr;15(2):e12709
pubmed: 30426668
Lancet. 2008 Sep 13;372(9642):902-9
pubmed: 18790313
Matern Child Health J. 2015 Jun;19(6):1306-37
pubmed: 25452215
AIDS Behav. 2012 Nov;16(8):2101-18
pubmed: 22116638